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Flashcards in Breast Path Deck (23)
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1
Q

Normal breast density is due to ___ and little ___

During menstrual cycle, under influence of __ and rising ___, cell proliferation__ and more ___ are formed

during preg and lactation, ___ changes and branching of ____ produces larger, more lobules

___ fxnally mature and differentiate to produce __

w age, stroma is replaced by ___

A

fibrous stroma, adipose

E/P, inc, acini

stroma, terminal ducts

Luminal cells, milk

adipose tissue

2
Q

Lesion
Non-proliferative __

proliferative dz w/out __
including ___ and ____

proliferative dz w ___
A and A

Carcinoma ___
D and L

risk for breast cancer inc moving ___

A

fibrocytic changes

atypia
sclerosing adenosis, papilloma

atypia
ADH, ALH

in situ
ductal and lobular

down

3
Q

Fibrocytic changes

__ and __ and ___ to varying extent

Not ___, no __ changes

No assc w inc risk of __

common finding is ___

A

Cyst, fibrosis, epithelial hyperplasia

clonal, genetic

BC

lumpy, bumpy breasts

4
Q

Adenosis

benign prolif of ___
Generally maintain normally arranged ____ and ___ components

__ lesion w variable inc number of ___

Types
S and C

Chief importance is occasional imaging/histo mimicry of ___

A

gland structures
epithelial/myoepithelial

lobular based, acinar structures

Sclerosing adenosis, complex sclerosing

invasive carcinoma

5
Q

Papilloma

Discrete benign tumors of ___ w/in ___ (intraductal)

More common in ___ of breast from ___

can occur __

can be __ or __ in contiguous branches of ductal system

A

epithelium, ducts

central portion, lactiferous ducts

peripherally

solitary, multuple

6
Q

Papilloma CM
Usually occur around ___ for peripheral
Solitary lesions in ___

MC primary sx soliatary
may be ___

____ or palpable tumo (peripheral) in on of quadrants

Typically grow ___

A

40s and 50s
6th decade

nipple discharge
bloody

subareolar mass

slow

7
Q

Proliferative breast disease w ____ (atypical ___)

___ prolif
may have chromo abberations including loss of ___ or gain of ___

some features of ___

assc w moderate inc risk of __

Two forms
Atypical __ hyperplasia aka
Atypical __ hyperplasia aka

chromosomal aberrations more commonly found in ___

considered a RF for __ in both breast

A

atypia, hyperplasia

clonal
16q, 17p

CIS

carcinoma

ductal
lobular
ALH

BC

8
Q

Ductal CIS

Malignant __ prolif of epithelial cells

inc risk of __

Harbor __ seen in invasive BC

limited to ducts/lobules by ___ (myoepithelial cells)

physical barrier and __ fxn

can be detected w ___, rarely as ___

freq assc w

A

clonal

BC

genetic alterations

basement membrane

tumor suppressor

mammogram, palpable mass

calcifications

9
Q

Morpholgic subtypes of DCIS

Comedo w high grade ___ and ___

Noncomedo w variable __

Nuclear __, s__, and ___ status are predictors of recurrence

Most women tx w ___

if untx, pts w small low grade DCIS develop cancer __

Tx is ___ (conservative __ vs __) w or w/out
usually __

Recurrence is half __ and __
RF for recurrence: high __, __, extent of ___ and positive ___

A

nuclei, necrosis

nuclear features

grade, size, margin

excision, radiation

to a lower degree

excision, lumpectomy vs mastectomy
curative

DCIS, invasive carcinoma

nuclear grade, necrosis, dz, surgical margins

10
Q

Lobular CIS
Clonal prolif w in ___
Grow in ___ fashion

Loss of ___ gene encodes for adhesion protein ___

can be ___ finding
Not assc w __ or __ that produces mammogram findings

RF for ___ in both breasts

tx options: __, __ w mammography, ___, and ___ mastectomies

A

lobules
dis-cohexive

TSG CDH1, E cadherin

incidental
calcifications, stromal rxn

invasive carcinoma

excision, close clinical follow up, tamoxifen, bilateral prophylactic

11
Q

Invasive breast carcinoma
divided into multiple clinical subgroups based on M, G, and M__ (including ER, PR, HER2)

__ bc
___ bc

wide variety of ___

majority are grouped and called ___

1/3 classified into ___ assc w bio characteristics (better)

A

morph, grade, molecular features

Famial
Sporadic

morph appearances

ductal

special types

12
Q

Sporadic
__ of cases
RF
H__ including age at __ and __, H__

Environmental __
__ fxn as promoter, stimulating ___ that can potentially accumulate ___ and give rise to ___

Once malignancy is established, hormoes can ___ growth, as well as ___ supportng __ and ___

A

majority
Hormone exposure, menarche/menopause, HRT

RF
Estrogen, epithelial cell prolif, DNA damage, carcinoma

stimulate growth, stromal cells, growth/development

13
Q

Familial breast cancer
Inheritance of ___
May be __, such as __

__ in remaining allele leads to ___

Major genes
B, B, T, C
__ w roles in ___ and maintenance of ___

Assc w other cancers such as __, __, ____

A

susceptibility genes
AD, TSG

2nd hit, loss of fxn

BRCA1/2, TP53, CHEK2

TSG, DNA repair, genomic integrity

ovarian, fallopian tube, prostate

14
Q

3 molecular subtypes
ER+/HER2
Dominated by genes regulated to __
Most common subtype in __

HER2+, ER+ or ER-
Arise through pathway strongly assc w amplification of ___ on chromo ___
Most common subtype in pt w __ in TP53 ( such as __)

ER-, PR-, HER2- (aka __)
Pathway independent of __
most common in ___ carriers

A

estrogen
BRCA2 cancers

HER2 gene, 17q
germline mutations, Li-Fraumeni

Triple neg breast cancer
ER and HER2
BRCA1

15
Q

ER+ HER-
Usually __ to __ tumors
___ women
Usually have __ (Low ___)

may __ but usually after __
survival w __ possible

Respond well to __ such as __ and ___

Chemo is not ___

A

well to moderately differentiated
older
best prog, low relapse rate

metastasize, 6yrs
metastatic dz

hormonal tx
tamoxifen, aromatase inhib

helpful

16
Q

HER2+, ER+/-
Arise through pathways assc w amplification of __ on 17q

usually in ___
___ mutation carriers

Gene expression patterns dominated by genes related to __ and __ pathways of downstream HER2 ___

metastasize to ___ >___ > ___

relapse pattern is __

survival w metastasis is

A

HER2 gene

non white, young women
TP53

prolif/signaling. RTK

bone, viscera, brain

short, rare

17
Q

HER stands for

HER2 pathway activates __ and ___ leading to proliferation

__ leads to survival

___ is available

Anti HER antibodies
Ab binds to receptor,
blocks __ and prevents __

results in no ___

A

Human epidermal Receptor

RAS, MAPK

PI3K

Targeted therapy

ligand binding, dimerization

signaling

18
Q

ER-, PR-, HER2- (Triple neg_

Typically ___ tumors
Common in __ (4/5 decade)
more common in __ and ___

relapse w in ___ yrs
survival w metastasis is ___

Complete response to chemo is ___

A

poorly differentiated
YW
AA and hispanics

5yrs
rare

rare

19
Q

Mutated BRCA1 on chromo __
__ inheritance

BRCA1/2 important for

BRCA1 mutation inc __
BRCA2 activates ___ at site of lesion

A

17
AD

DNA repair

phosphorylation
RAD51

20
Q

Invasive lobular carcinoma
May form ___
Infiltrative pattern w ___ borders

lack ___ (mammography)

Histo hallmark is ____ infiltrating tumor cells, single file w ___ cells

Typically __ and __ +

A

irregular masses
hard to determine

desmoplasia

discohesive, signet ring

ER and PR

21
Q

Stromal tumors aka __

most common \_\_\_
Young age \_\_/\_\_s
mass is \_\_\_
Composed of both \_\_ and \_\_ cells 
\_\_ responsive

may be ___ or replace __

A

fibroadenoma

benign tumor
20/30s
palpable
stromal/epithelial
hormonally

small, whole breast

22
Q

Stromal tumor P___
Tumor of both __ and ___ cells
Rare and occurs at __

Clonal w acquired ___
most commonly gains __

can be ___ or have ___

surgical exision w ___

A

phyllodes tumor
epithelial/stromal
any age

chromo change
1q

high grade, aggresive clincal behavior

clear margins

23
Q

Paget’s dz of nipple (eczema appearance)

Palpable ___

majority have underlyin ___

tumor is __, typically ___

Tx is ___ w/wout ___

A

subareolar mass

invasive disease

poor diff, ER-

excision, radiation